$250 Prescription Drug Rebate Payment For Doughnut Hole Medicaid Gap

by Lance

One of the immediate changes which will result from the historic 2010 health care bill will be a $250 payment to help with prescriptions. There are quite a few Americans who have a drug coverage gap known as the “doughnut hole”. This gap in Medicare D Drug benefit program means that assistance from Medicare for different levels of annual drug costs is not consistent through different levels of annual costs.

Right now the following costs (which include drug costs and Medicare payments) are covered as shown:

$0 to $295 – No coverage – patient pays 100% of the costs.

$295 to $896.25 – 75% is covered by Medicare.

$896.25 to $4,350.25 – nothing is covered by Medicare – This is known as the “doughnut hole“.

$4,325.26 and up – 95% covered by Medicare.

Medicare Part D is a program to help subsidize the prescription costs of Americans and has been in place since January 1, 2006. It was introduced as part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

Is this $250 rebate permanent?

No, but the drug companies will be lowering the prices on their brand-name drugs by 50% starting in 2011 and 75% by 2020 which will completely close the doughnut hole so this rebate won’t be needed anymore.

How do I claim my $250 prescription payment?

If you are eligible for the tax free $250 rebate, then Medicare will automatically send it to you. You don’t need to do anything. No forms, no phone calls – nothing!

When will I get the $250 rebate check?

The $250 checks will begin to get mailed starting in mid-June of 2010. You only get a check if you are in the “doughnut hole” coverage gap. The checks will be mailed throughout the year, but only to new people who have reached the coverage gap. You can only get a maximum of $250 and no more.

$250 Drug Rebate Scams

Please be aware that there are people who are trying to scam seniors into handing over their personal information by telling them it’s necessary to get the rebate. This is not true. Nobody should call you about the rebate – if they do, then don’t give them any information at all.

There are even more people that will be grateful, as it’s not just for seniors on Supplemental Security Income (SSI). It appears that anyone of any age, who is on Social Security (SS) or Social Security Disability (SSD), will also receive this very helpful assistance. What a great thing to do.

The $250 rebate is only for Social Security recepients who have actually had drug costs that put them in the donut hole. They must have Part D and be currently enrolled in a CMS approved Part D plan. Until you fall into the donut hole you can’t expect to receive the rebate.

I am enrolled in a Medicare Adantage Plan administered by Highmark Blue Shield in Pennsylvania[Freedom Blue]. My perscription drug coverage has a “donut hole” where I am subject to a 50% copay. Am I entitled to the $250 rebate? Must I complete any forms to receive this rebate? When might I expect the rebate?

One of my prescriptions cost $800. a month. (Cephalon manufactures it.) I have to go to India to order a generic (not available here) for this med and it is still 150.00 month. I also have 10 more prescriptions. None of these are narcotic or addicting. I don’t quite qualify for Medigap but I spend approx. 1/3 of my SSDI on medical per month.
When will there be a consideration for how much of a percentage of your income you spend for medical costs to qualify for assistance. I understand how people live in the streets because they cannot get the medication they need !!!!!

I entered the donut hole in August. I called Medicare and was told that I should get my 250.00 check by October 27th. I think she ment september 27th. I entered the gap 08/26/2010, if I don’t get a check until 10/27/2010 that will be over 60 days and I thought it was supposed to be within 45 days. Could it be that the representative I talked with was wrong and meant to say 09/27/2010?

I reached the donut hole in Oct., have not recieved my check yet. I called medicare and they said it goes by a schedule. Would be sometime in 2011. Hope this helps someone. If you have a question call medicare. They should be able to tell you something.

This is from the Centers for Medicare & Medicaid Services brochure: “If you hit the donut hole after the program has begun, you should expect to receive your check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing…..If you don’t get your rebate check, contact Medicare at 1‑800‑MEDICARE. Individuals receiving Medicare Extra Help will not receive a rebate check.”

I reached the donut hole in Dec 2010 and have not yet gotten my check. It is now Jan 31, 2011. I will wait a while longer, but will likely call if I don’t get a check by the end of Feb.

I went into the donut hole on December 9, 2010. I believe the 45 day timeline has been passed. I cannot seem to obtain closure from Medicare, Social Security, or my Part D provider as to when to expect the rebate. No one seems to have knowledge of when the check is to be mailed. This system does not appear to be working.